In his book No B.S. Ruthless Management of People and Profits marketing guru Dan Kennedy states that there are two steps to take to thrive in business during economic downturns or what he calls "crisis opportunities".  The first step is to "provide an ever escalating, exceptional, even phenomenal level of customer service, delivered by exceptionally competent, highly trained, highly incentivized, and highly policed humans."  While all of the other masses of businesses in your field and in general are doing the opposite and cutting costs by cutting level of service you will be able to distinguish yourself by providing exceptional service.  The second step is to "design your business and aim your marketing at the affluent consumers who are least affected by overall economy ups and downs, who do not use price as a decision factor, who have demonstrated preference for exceptional service and a willingness to pay for it."  While at first glance this may not seem like very practical advice for a medical practice, members of the Top Practices Mastermind group know that there are all kinds of ways for podiatrists to up sell and cross-sell to their patients who are not limited by cost and health insurance restraints.